198602245-11-7-2024-28-AS-RORN-DB5SQW-20241118130522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602245
Report Date: 11/07/2024
Date Signed: 11/07/2024 01:03:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/31/2024 and conducted by Evaluator Jose Villalobos

COMPLAINT CONTROL NUMBER: 28-AS-20241031164014

FACILITY NAME:	GARFIELD VILLAS LLC		FACILITY NUMBER:	198602245
ADMINISTRATOR:	SANDOVAL, ROSALIE		FACILITY TYPE:	740
ADDRESS:	1425 N GARFIELD AVE		TELEPHONE:	(626) 398-3261
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	40	CENSUS: 13	DATE:	11/07/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Rosalie Sandoval		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff did not keep the facility free of bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation for the allegation above. LPA met with administrator Rosalie Sandoval and the purpose of the visit was discussed.

On todays visit, LPA conducted the following: LPA toured the physical plant that included resident rooms, Interviewed Staff #1-#4 (S1-S4), interviewed residents #2-5 (R2-R5) , Collected documents for pest control from the last 3 months, collected copies of documents from Resident #1 (R1s) File, and collected copies of the staff and resident roster. R1 was unavailable for interview. The investigation revealed the following:

In regards to the allegation "Staff did not keep the facility free of bed bugs" it is alleged that R1's room and the facility has a bed bug issue not being addressed. (4) of (4) Staff interviewed denied the allegation. (4) of (4)...

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20241031164014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GARFIELD VILLAS LLC	FACILITY NUMBER: 198602245
	VISIT DATE: 11/07/2024

NARRATIVE

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Residents interviewed could not corroborate the allegation. LPA observed rooms #86, #70, #78, #79 and #80. LPA did not observe any bed bugs. Residents interviewed stated they could not recall any issues of bed bugs in the facility. Staff interviewed stated that the facility has a contract for pest control services to be completed monthly. File review of the pest control invoices does not show any notes or observations of bed bugs in the facility. R1's file does not show any notes or documentation of having bed bugs. Based on interviews, file review, and observations conducted, there was not enough supportive evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit Interview conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

LIC9099 (FAS) - (06/04)

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